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   Table of Contents - Current issue
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January-June 2022
Volume 13 | Issue 1
Page Nos. 1-60

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REVIEW ARTICLE  

Gastrointestinal stromal tumor – A systemic review literature Highly accessed article p. 1
Debajani Deka, Md Faizzal, Bipul Kumar Das
DOI:10.4103/atp.atp_5_22  
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract and originate from the interstitial cells of Cajal. They arise most commonly from the stomach or small intestine, with a median age of 60 years. We did not find any relationship between GIST and ABO blood group and Rh factor. Mutations in KIT exon 11 are found to be more common in larger tumors, and the presence of this mutation has been shown to have an adverse prognostic influence. Deletions compared with point mutations in exon 11 have also been found to be a significant unfavorable factor in patients with gastric GISTs. The study group includes all cases of GIST and extra-GIST. Review literatures were taken from Internet Google search and some websites of high index journals. The data extruded mainly were sites of the gastrointestinal tract, histological types, different immunohistochemical markers, etc., Stomach is the most common site of GIST around 70%. Spindle cell is the most common histological variety; CD117 is frequently found immunohistochemical finding. From the abovementioned results, we can easily come to the diagnosis of specific type of GIST and its respective therapeutic measures.
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ORIGINAL ARTICLES Top

Human epidermal growth factor receptor-2 overexpression in endometrial carcinomas at a tertiary center in Sub-Saharan Africa p. 4
Segun S Odetola, Mustapha Akanji Ajani, Ifeanyichukwu D Nwanji, Ayodeji A Salami, Clement Abu Okolo
DOI:10.4103/atp.atp_6_22  
Background: Endometrial cancer is the third most common gynecological malignancy, following cervical and ovarian malignancies. Prognosis among the women of African origin is, however, worse as they tend to have high-grade tumors and late presentation. Close to 50% of high-grade endometrial cancers show human epidermal growth factor receptor 2 (HER2) overexpression and may thus benefit from targeted treatment. Aims: This study aimed to determine the overexpression status of HER2 protein among the cases of endometrial carcinoma. Materials and Methods: All cases of histologically diagnosed endometrial carcinoma from January 2007 to December 2016 were retrieved from the files and records of department of pathology in our hospital. Cases were classified and graded according to the World Health Organization (2014 version) classification of endometrial carcinoma followed by immunohistochemical staining for HER2 overexpression. Results: There were a total of 51 cases of endometrial carcinoma that met the inclusion criteria during the study. The mean age of patients was 63 years. As a group, nonendometrioid carcinomas predominated (55%). The majority (70%) of cases showed high-grade histological morphology. Positive Her2/Neu expression was seen in 11 cases (22%) of endometrial carcinoma. There was no statistically significant association between hormone expression status and age, histological variant, or grade. Conclusion: Endometrial carcinomas among Nigerian women are predominantly nonendometroid and high grade. HER2 overexpression was seen in a fifth of cases. Future studies should explore the response of targeted therapy among Nigerian patients showing HER2 overexpression.
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An assessment of infection prevention and control in hospitals in Akwa Ibom State, Nigeria p. 8
Agantem Ekuma, Ini Etukudo, Asukwo Onukak, Rosemary Umoh, Betini Christian
DOI:10.4103/atp.atp_1_22  
Background: Infection prevention and control (IPC) programs are important in controlling healthcare associated infections (HAIs). In low and middle income countries, IPC programs targeting HCAIs are frequently underdeveloped and sometimes nonexistent. Aim: The aim of this study was to assess and identify gaps in IPC practice across selected hospitals in Akwa Ibom State. Methods: This was a survey of hospitals in Akwa Ibom State in Southern Nigeria. Information for each hospital was provided by IPC representatives of each hospital through a 24 point questionnaire covering administrative controls, hand hygiene, available laboratory tests for infections, and waste disposal. Results: There were 25 hospitals across 15 local government areas in the state included in the survey. The average number of beds in the hospitals was 57 (6–300); the average number of wards was 6 (1–20); the average number of staff was: doctors 9 (2–40); nurses 33 (6–200); other staff 19 (3–100). There were 16 hospitals with a designated staff to oversee IPC activities, 4 with a staff dedicated to IPC activities, and one with a written IPC policy. Adequate number of hand washing stations was reported in 11 centers while 9 had regular supply of running water and 9 had regular supply of alcohol based hand sanitizers for hand hygiene. There was low capacity for onsite microbiology cultures to identify infectious agents, although most centers had HIV and hepatitis B virus rapid diagnostic test kits. Conclusion: There are variable levels of implementation of IPC in hospitals in Akwa Ibom State with a lack of structure, guidelines, and resources being a hindrance to high level of IPC in these hospitals.
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Histopathological spectrum of benign lesions of the breast from a university teaching hospital in Northern Nigeria p. 12
Murtala Abubakar, Balarabe Kabir, Almustapha Aliyu Liman, Sani Mohammed Shehu, Saad Aliyu Ahmed, Peter Pase Abur, Mohammed Bashir, Zainab A Adamu, Kamarudeen Owolabi Sani, Murphy Ibiam Osita-Ufere, Shehu Abdullahi, Aliyu Usman Bappa
DOI:10.4103/atp.atp_19_21  
Background: Benign breast diseases (BBDs) are a term that refers to a heterogeneous group of lesions of the breast that are not malignant. They are more common than malignant breast lesions and are important because of the need to differentiate them from breast cancer and for the increased risk of cancer development associated with some behavior-driven development. Aims: The aim of this work was to classify and study the clinicopathological patterns of BBDs as seen in our hospital. Methodology: All benign breast lesions diagnosed in our over the study period were studied. Data were extracted from patients' request cards, hematoxylin- and eosin-stained slides, and histopathology reports issued for each of the cases. The data were analyzed and presented in tabular formats. Results: Four hundred and fiftyfour cases of BBDs were recorded over the study period. 96% of these cases were reported in the female patient. The mean age of our patients was 29.62 ± 8.86 years with the age group of 21–30 years having the highest frequency. Fibroadenoma (FA) (226 cases) was the most common followed by fibrocystic diseases (FCDs). Four cases of atypical ductal hyperplasia were seen. Lesions of the male breast were seen in 18 patients and all were cases of gynecomastia. Conclusion: BBDs are the most common histologically diagnosed breast diseases in our center. FA, and FCDs were the most common BBDs. A relatively low prevalence of premalignant lesions not reflective of the high incidence of breast cancer in our environment was observed. Routine mammographic screen for these lesions is therefore recommended.
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Prevalence and correlates of metabolic syndrome in patients receiving highly active antiretroviral therapy attending infectious disease clinic in a southwest tertiary health institution in Nigeria p. 18
Afolabi A Salawu, Rofiat A Kareem, Elizabeth O Oke, Taiwo Wulemot Oloyede, Samson A Ojedokun, Kunle Oreagba
DOI:10.4103/atp.atp_18_21  
Background: The introduction of HAART has led to significant decline in morbidity and mortality in HIV/AIDS patient however not without the emergence of a number of metabolic derangements. Materials and Methods: The study adopted cross sectional design carried involed one hundred and fifty participants who fulfilled the inclusion criteria. 10mls of blood samples was collected after overnight fasting, distributed into appropriate specimen bottles for fasting blood glucose, CD4 count, viral loads and lipids profile assays. Results: There mean age was 41.94 years with female preponderance and male to female ratio of 1:3.81. The common ART used among subjects was tenofovir/lamivudine/dolutegravir (98.4%). The log mean CD4 count was 5.58. The prevalence of abdominal obesity among subjects was 42.4% according to National Cholesterol Education Program for Adult treatment Panel III (NCEP-ATP III), and a higher prevalence of 56.8% according to International Diabetes Foundation/joint interim statement (IDF/JIS) criteria. High fasting glucose was evident in 24.8% (n = 31), hypertriglyceridemia in 12.8%, majority (76%) had low high-density lipoprotein and high blood pressure in more than one third (43.2%) of the population. The prevalence of metabolic syndrome among subjects ranged between 35.2% and 43.2% according to the NCEP-ATP III, IDF, and JIS criteria. Conclusion: The prevalence of metabolic complications of HAART in patients with HIV infection observed in this study is high despite improvements in morbidity and mortality conferred by immune reconstitution. The long-term effects of these metabolic complications indicate the need for concern and active preventive measures. These findings call for an integrated management strategy.
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Molecular identification of Onchocerca species among residents of benue and cross River States, Nigeria, Using Known Microsatellites and Mitochondrial DNA p. 23
Odama Richard Ikani, Agada Ali Samuel, Amechi Nmesomachi Joy, Kenechukwu Chibuike Onyekwelu, Akighir John, Ezeh Charles Ogbonna
DOI:10.4103/atp.atp_15_21  
Background: Human onchocerciasis is a neglected tropical disease caused by Onchocerca volvulus and is transmitted by the species Simulium damnosum. Currently, onchocerciasis is estimated to have infected over 37million people in tropical Africa, Yemen and Latin America, resulting in a debilitating eye and skin disease in more than 5million people with over 1.2 million cases of visual impairment or blindness. Also, an estimate of about 120 million people is at risk of contracting the disease due to the breeding habit of the vector. Community-directed ivermectin administration has greatly reduced the infection burden in different parts of the world but they are persistent cases of onchocerciasis infection in Benue and Cross River States, Nigeria due to the terrain, relapse/poor ivermectin coverage, and COVID-19 outbreak. Aims and Objectives: To investigate the prevalence of onchocerciasis in these localities, this study reported the use of mitochondrial DNA and microsatellite markers for molecular identification studies of Onchocerca species amongst residents of Benue and Cross River State, Nigeria. Materials and Method: Three hundred (300) patients from Benue and Cross River State, Nigeria, 150 patients each from both states were screened using SD Bioline onchocerciasis test strip from South Korea with batch no: 61ADE002B for the detection of IgG4 antibodies against Ov16 in onchocerciasis. 25 were positive from Cross River State and 20 from Benue state. Six (6) from each state were sent for DNA extraction and PCR amplification (L1-6=Benue State, L6-12= Cross River) using polymerase chain reaction (PCR) amplification of mitochondrial cytochrome C oxidase subunit I (COXI) genes using HC02198: 5'-TAAACTTCAGGGTGACCAAAAAATCA-3' primers and the primers of the respective microsatellites; (GT)AT(GT)AT(GT)10, (GT)GC(GT)10, (CAG)2(CAA)10(CAG), and (GT)11TT(GT). Results: The results showed amplification of COX 1 subunit of the mtDNA of onchocerca volvulus at 344bp DNA sequence and amplification of (GT)AT(GT)AT(GT)10 microsatellites at 193bp, (GT)GC(GT)10 at 180bp, (CAG)2(CAA)10(CAG) at 209bp, and (GT)11TT(GT) 195bp respectively. Conclusion: This study clearly showed that active transmission of human onchocerciasis infection is still ongoing in Wanikade and Igede communities of Benue and Cross River State as evident by the skin lesions and depigmentation presented by a 55 years old woman and the molecular parasitological evidence of the incidence Onchocerca volvulus using the parasites' genetic materials. Therefore, we recommend intensifying community-directed ivermectin intervention in these states.
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Asymptomatic bacterial vaginosis and associated risk factors among undergraduate in a tertiary institution in Ogun State, Nigeria p. 29
Babatunde Tayo, Charles John Elikwu, Tinuade Adesola Ajani, Chika Celen Okangba, Chinenye Gloria Anaedobe2, Victor Ugochukwu Nwadike, Opeoluwa Akinyele Shonekan, Azubuike Chidiebere Omeonu, Oluwaseun Bibitayo Faluyi, Grace Imangbe, Bassey Imaobong Udoh, Chimdi Eleweke, Onyinyechi Okam, Kelechi Emeka Nwonyi, Abimbola Oladayo, Folarin Atalabi
DOI:10.4103/atp.atp_11_21  
Background: Bacterial vaginosis (BV) is a disease condition in women with adverse health outcomes. Proper clinical diagnosis of BV is difficult because a larger percentage of women are asymptomatic until they come down with its sequaele. Therefore, this study was aimed to determine the prevalence of asymptomatic BV among undergraduate female students of Babcock University in Ogun State Nigeria and to detect the risk factors associated with it. Materials and Methods: A descriptive cross-sectional study involving 200 asymptomatic undergraduate female student of Babcock University from September 2018 to November 2019. Information was obtained, using structured questionnaire, on sociodemographic and behavioral characteristics considered risk factors of the respondents. High vaginal swabs were collected from each of the participants, made into thin smears and were Gram stained. Modified Nugent criteria were used to analyze the specimen and make a diagnosis of BV. The data were analyzed by IBM Statistical Package for the Social Sciences software version 20 (SPSS Chicago, IL, USA). Results: The prevalence of asymptomatic BV among the study participants was 35/200 (17.5%). Vaginal douching (Odd's ratio [OR] = 3.3, 95% confidence interval [CI]: 1.49–7.33), smoking (OR = 3.2, 95% CI: 1.16–8.80), previous history of reproductive tract infection (OR = 16, 95% CI 3.99–64.11), and wearing of nylon underwears (OR = 5.21, 95% CI: 1.23–21.88) were the factors with increased likelihood of BV on multivariate analysis. Conclusion: The prevalence of BV among the asymptomatic population in this study is high. The risk factors found suggest that there should be preventive program strategies such as education on risky behaviors.
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CASE REPORTS Top

Nodular Hyperplasia of the Bartholin's Gland: An Overlooked Clinical Entity p. 33
Sebastian Anebuokhae Omenai, Sunday Eghosasere Omozuwa, Michael Chukwugoziem Nweke
DOI:10.4103/atp.atp_2_22  
The Bartholin gland can give rise to several lesions that include: cysts from duct obstruction, carcinomas and much rarely nodular hyperplasia and adenomas. Nodular hyperplasia is an under-reported entity that most often presents as a Bartholin cyst to the gynecologist. We report a case of a 21-year-old Nigerian student who presented with a nontender left cystic vulva swelling with associated vaginal discharges and occasional pains of a month duration. She had an excision of the nodular mass that was seen on the marsupialization of the cyst. The histology of the excised tissue showed nodular hyperplasia of the Bartholin's gland. Tumors of the Bartholin glands are rare in general, with malignant neoplasms easily differentiated from benign ones with histology and clinical presentation. However, benign neoplasms and reactive conditions of the Bartholin glands can easily be confused as both have similar clinical presentations. This distinction is easily made with histology.
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Rhinoscleroma: A report of three cases with unusual headache presentation and literature review p. 36
Modupeola Omotara A. Samaila, Harrison David Lawan, Ifusumu Yirom Rimamskep
DOI:10.4103/atp.atp_24_21  
Rhinoscleroma is a rare endemic disease in low socioeconomic settings characterized by nasal growth, nasal blockage, and epistaxis. The causative organism is not an usual nasal commensal, and diagnosis is often delayed. Characteristic Mikulicz cells should be visualized microscopically for definitive diagnosis. We present our experience of rhinoscleroma with unusual presentation of severe headache and orbital mass in three patients over an 11-year period in the pathology laboratory of a tertiary hospital.
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A case report of coexistence of microfilaria with anaplastic carcinoma of thyroid p. 40
Manish Kumar Saroj, Avinash Singh, Sneha Aditi, Ruchi Sinha
DOI:10.4103/atp.atp_21_21  
Even in the 21st century, filariasis still remains one of the major health problems plaguing India. Filariasis usually presents as superficial swelling and lymphedema. It is uncommon for microfilaria to be seen during routine cytological examination. It is even rarer to find microfilaria coexisting with neoplastic lesions. Ninety-five percent of cases of lymphatic filariasis are caused by Wuchereria bancrofti and are rarely found in the thyroid gland. Here, we report a case of a 47-year-old male who presented with midline neck swelling, for which he underwent fine needle aspiration cytology which showed microfilaria coexisting with anaplastic carcinoma of the thyroid gland.
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Pseudomyxoma peritonei originating from gynecological diseases: An incidental pathological diagnosis p. 43
Modupeola O Samaila, Afolabi K Koledade, Rimamskep Ifusumu, Shehu Abdullahi, Usman A Bappa, Adebiyi G Adesiyun, Fadimatu Bakari, Aminatu Makarfi, Ibrahim A Adekanbi, Abbas Iliyasu, Sakina Ghazali
DOI:10.4103/atp.atp_10_22  
Psuedomyxoma peritonei is an uncommon disease characterized by the presence and accumulation of gelatinous material in the pelvis and abdominal cavity. It is an unusual manifestation of mucinous ascites of controversial origin, though often associated with a primary tumour of the appendix. Diagnosis of pseudomyxoma peritonei is often incidental during exploratory laparotomy because there are no specific diagnostic clinical symptoms. We report three females with gynaecological diseases with incidental finding of pseudomyxoma peritonei in the absence of appendiceal or gastrointestinal tumour. Tissue biopsies were fixed in 10% formalin and processed in paraffin wax. Representative sections were stained with haematoxylin & eosin, periodic acid Schiff, diastase and mucicarmine. Three females aged 25years, 42years and 50years presented respectively with a year, 5years and 12years history of abdominal swelling and abdominal mass. The older female also complained of vaginal protrusion with significant weight loss. Clinical diagnosis in the two younger females was advanced ovarian carcinoma, while the older female was diagnosed with third degree utero vaginal prolapse. All three had exploratory laparotomy which revealed unilateral multi lobulated left ovarian masses, with extensive mucinous peritoneal and omental deposits. There were no obvious gastrointestinal lesions and the appendices had no gross pathology. Two of the patients had oophorectomy with peritoneal and omental clearance of mucinous materials while the third patient had vaginal hysterectomy and peritoneal clearance of gelatinous deposits. The gelatinous materials showed papillary and multi locular cystic masses containing gelatinous fluid. Histopathological diagnosis of pseudomyxoma peritonei in a background of mucinous ovarian cystadenoma, and utero vaginal prolapse with epidermialization of the cervical lining epithelium was made. Pseudomyxoma peritonei occurs in the absence of a primary appendiceal disease and there are no specific diagnostic clinical symptoms. Definitive diagnosis requires histopathological analysis however, clinicians should entertain a high index of suspicion during laparotomy when mucin pools are present in the absence of gross pathology particularly in females with benign gynaecological diseases. Our cases were classed histologically into the benign disseminated peritoneal adenomucinosis type.
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Unforeseen gastrointestinal events following antituberculous therapy p. 47
Sandheep Janardhanan, Saji John Varghese, Benoy Sebastian, Sunil Mathai
DOI:10.4103/atp.atp_13_21  
Eosinophilic enteritis is a rare entity affecting human gastrointestinal tract. The exact etiology is unknown, and some drugs are implicated in causing this condition. We report a case of drug-induced eosinophilic enteritis, caused by antituberculous therapy (ATT). The cessation of ATT-induced clinical remission and symptoms were reproduced on drug re-challenge, which corroborated our diagnosis.
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Adenotonsillar kaposi sarcoma with severe upper airway obstruction in acquired immunodeficiency syndrome-related disseminated disease – A case report and literature review p. 51
Oladeji Raheem Quadri, Aliyu Ibrahim Lawan, Nurudeen Adebola Shofoluwe, Abdulmajeed Ibrahim Yahya
DOI:10.4103/atp.atp_12_21  
Reported cases of upper airway obstruction (UAO) due to obstructive adenotonsillar Kaposi sarcoma (KS) are rare in our environment. We report a 29-year-old human immunodeficiency virus (HIV)-positive female Nigerian who had defaulted treatment for 6 years but represented with disseminated KS and features of severe UAO that necessitated emergency tracheostomy and adenotonsillectomy. She had remarkable improvement in her breathing, feeding, and speech while being in a stable and satisfactory clinical state postoperatively until 3 days later. She suddenly deteriorated and died. Histology report of the adenoid and tonsillar tissues revealed features in keeping with KS (nodular stage). Lack of compliance with antiretroviral therapy and default from care could have facilitated the development of an aggressive KS and the rare presentation. Adherence to the management protocol of HIV infection would bring about early detection of KS, which can be promptly managed with a possible favorable outcome, thereby preventing or reducing dissemination.
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CLINICAL DISCOURSE Top

A comparative study of factor VIII levels in fresh-frozen plasma from whole blood stored at varying temperatures and durations p. 56
Ann Abiola Ogbenna, Kunmi Mathew Oyewole, Titilope Adenike Adeyemo, Fikewa Oyedele, Dorcas Olubunmi Oyelaran
DOI:10.4103/atp.atp_17_21  
Background: In Nigeria, fresh-frozen plasma (FFP) is an important plasma product to provide coagulation factors such as factor VIII (FVIII) in patients with FVIII deficiency and is still the only product available for the treatment of hemophilia A and B in some countries where recombinant factor concentrate is not available. FVIII is a labile coagulation factor and a quality marker of fresh-frozen plasma. In this study, we assessed the effect of storage temperature and time on FVIII yield. Methods: This was a descriptive-analytical study of a random selection of 136 blood donors, randomly divided into four groups. Whole blood (WB) was collected into 450 ml of blood bag from each participant and an additional 4.5 ml was collected into citrated bottle containing 0.5 ml citrate for baseline FVIII assay. WB from donors in Group A and Group B were stored at 20°C–24°C for 6 h or less and 12 h, respectively, while Group C and Group D were stored at 4°C for 12 h and 24 h, respectively. FFP was prepared from the WB after storage and FVIII levels were determined using Sysmex CA-101 based on the principle of turbo-densitometry principle with automatic zero adjustment and magnetic stir bar for homogenizing the test suspension and for increased sensitivity. The level of FVIII in FFP produced at various storage conditions was determined. Percentage yield was calculated as median level of FVIII in FFP per group/median level of FVIII in citrated plasma per group ×100. This is the proportion of FVIII in FFP relative to the level at baseline in the donor unit, whereas the FVIII level is an indication of just the level in the produced FFP. Results: The median FVIII level in FFP from Group A and B was 0.87 IU/ml and 0.82 IU/ml, respectively. Similarly, the median for Group C and D were 0.86 IU/ml and 0.76 IU/ml, respectively. The highest yield was observed in FFP prepared within 6 h or less of blood sample collection and least yield after 24 h of storage at 4°C. Conclusion: The yield of FVIII produced from WB under the varying temperatures and durations of storage studied is above the recommended level of 0.7 IU/ml; hence will be effective for replacement therapy in hemophiliacs. However, the best yield is obtainable from WB stored at 20°C–24°C for 6 h.
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ERRATUM Top

Erratum: The hemotological profile in COVID-19 infection: A mini-review p. 60
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DOI:10.4103/2251-0060.353208  
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